With apologies to Randy Shilts for playing with his title, we bring
you the next chapter in the saga of the AIDS MOBILE as it plays its
message of AIDS prevention in the heartland and wherever it is welcome.

Andy and Sonny, about whom you've read, were driving the van
back from a testing site when they stopped at a filling station in a
mountain village. The attendant paled when he read the words "AIDS
MOBILE' and saw the two men exit the sleeper van. "Two men . .
. AIDS . . . no way . . . you pump your own gas,' he told them,
backing off and standing his ground. Andy and Sonny laughed about it,
and they find that those who at first appear irrationally fearsome soon
laugh with them when they take time to explain how AIDS is really
spread-- primarily by sex and blood.

I discovered that you have to be careful about emphasizing the word
"blood.' A young man who resembled a Harlem Globetrotters
basketball star wanted to talk to us in the AIDS MOBILE. I cautioned
him that sleeping with a woman is like sleeping with all her sex
partners for the past ten years. His eyes widened. He broached a
concern: "What if accidentally her period had come up on her and I
got that blood on me during sex--would I get AIDS?' He was so
comical I could hardly keep a straight face. It would have been funny
had his misconception not been so serious. I went back to basics and
explained to him that the vaginal fluids from a sexual partner are all
that are needed to infect him if his partner is an AIDS carrier. He
knows now that blood isn't the only culprit in spreading a sexually
transmitted disease. I believe the AIDS virus has been found in all the
body fluids, I told him.

Andy and Sonny learn more about their fellow Americans every day,
and from hearing their experiences, you come away reassured that people
are basically decent about AIDS. They laugh about their fears when they
have the facts explained to them. When they believe that what you are
telling them is the truth, they can handle it.

The AIDS MOBILE staff has tested 1,056 individuals and discovered
28 to be AIDS positive.

We have tested people of high risk, low risk, and medium risk. From
our experience the argument that widespread testing will drive high-risk
persons underground just doesn't hold up. It may sound good in
theory, but out in the real world, in practice, it appears not to be a
problem at all. People at all risk levels seem anxious to be counseled
and tested--freely and voluntarily (confidentially or anonymously, as
they wish).

After having interviewed these people, Andy estimates that 95
percent of the persons at risk in the country would gladly be tested
voluntarily if it were free and convenient to do so. There's
persistent talk that mandatory testing would drive high-risk persons
underground, but we haven't found anyone wanting to go underground
with voluntary testing. So why don't we spend our resources on
voluntary testing? Because there is yet another argument: "We
can't do widespread voluntary testing because there are too many
false positives.'

The Department of Defense has tested in excess of 4 million persons
and has recently assessed a false-positive rate of 1 out of 135,000
low-risk individuals (after repetitive ELISA positives and a
confirmatory Western blot). The one false positive could be checked
further by studying T cells and by culturing the virus from the blood.

An infectious disease specialist at Indiana University, Dr. Judith
Johnson, said: "I don't want any AIDS antibody-positive
individuals to dimiss their results as being false positive. I fear
that patients may deny their high-risk behavior and rationalize away
their test results. Most seropositive people, if they review their past
history, will be able to find some risk factor,' she said.
"For example, after thinking about a positive AIDS diagnosis, a
patient might make a comment like "Well, I did have surgery in 1980
with blood transfusions.' Persons who truly cannot find any risks
should talk to their doctor about further tests.'

We talked with Dr. Brooks Jackson at the St. Paul Red Cross and to
State Epidemiologist for Minnesota Dr. Michael Osterholm. After
testing more than 250,000 low-risk patients, they had no false
positives. These were low risk, all right--they were blood donors--all
250,000-plus of them. They found 15 positives, confirmed by the Western
blot. How did they know that they weren't false positives? Each
of the 15 admitted to being high-risk. The actual AIDS virus was
cultured from the blood of all 13 patients who have come in to date for
follow-up blood testing. The fourteenth patient was already
symptomatic. The fifteenth admitted to high-risk behavior.

Having just completed the cultures, Drs. Osterholm and Jackson
will be submitting the results of their research for publication. It
takes a month to culture out the AIDS virus. The procedure costs about
$150 at the present time, but it is expected that this cost will soon
drop.

As you can see, this could lay to rest the "head in the
sand' attitude that fear of a false-positive test should prevent
the testing of low-risk populations. Because the test is so accurate,
it should become a routine part of physicals for those who believe they
have even the slightest risk.

We asked Dr. Jackson how he thought we should handle the
complaints of those who say, "Don't test because some labs
might give false positives.'

"Should we use regional centers?' we asked him.

"Well, that's one approach,' he said. "And the
other approach is that they let anybody do it and have them pass
proficiency panels [tests]. License laboratories that way. You just
give them panels to do, and if they pass the panels then you know
they're qualified to do it. I hesitate to restrict it to certain
centers, although our center would certainly benefit from that. But the
lines are just so long to get tested these days.

"They must wait 5 weeks, 10 weeks, and at some places 14 weeks
to get an AIDS test. Just to get blood drawn to be tested! You
shouldn't have to wait that long.

"And you see, a lot of that is because many centers are making
it mandatory that they provide pre-test counseling at the same time. I
don't think it's really necessary for low-risk people. You
know, people who just want to find out. And of course this counseling
takes a tremendous amount of time, and that really backs everything up.
They may have the results, but they won't give them to you until
you come in for counseling to reduce your high-risk behavior.

"And in the low-risk groups this just takes much time and
money, and I'm not sure if it's really necessary in those
groups.'

I asked him, "Do you mean people who had blood transfusions
who just want to know? Or maybe their child who had a blood transfusion and is now six years old--if negative, why would he need post-test
counseling to change his lifestyle?'

"Right,' Dr. Jackson said. "I agree, and it should
be made easy and accessible to these people. In fact, I don't even
think they should have to see a physician. I mean, if they just want to
go in someplace and say, "I just want an AIDS test,' they
should be able to get it done and pay their ten dollars or something and
get it done. Now, if it comes out positive, I would say that that lab
should refer them to a physician for counseling.

"But if you just want to get a simple result back, just for
assurance, I think that's perfectly O.K., as long as the labs are
qualified to do it and it can be done with a proficiency panel or
something that they have to do every three months or six months or
whatever. I think that would be the approach to go.

"I still think it is a good idea to identify them [the
low-risk AIDS-positive individuals]. Certainly, having dealt with so
many of these people at the blood center, I know that all they want is a
little assurance, and I just think you should make it as accessible as
possible. It's such a cheap test! We only charge seven dollars
for it. I mean, this is nothing, you know.'

Dr. Jackson is the assistant medical director at the St. Paul Red
Cross and the assistant professor of laboratory medicine and pathology
at the University of Minnesota. "The University of Minnesota has an
AIDS Treatment Evaluation Unit. We're one of the 19 centers,'
he said. "We mainly focus on antigen testing and culture testing.
Of course, we do a lot of antibody testing for the Red Cross.

"I've noticed that those who extrapolate about the risk
of getting false positives in the low-risk population make it sound a
lot worse than it is,' he said.

Dr. Jackson's views about the accuracy of antibody testing
seem consistent with those of FDA authorities whose interviews we
published in the September '87 Post.

On page 60 of this issue is an expose on the gross inaccuracies of
Pap smears. A false negative could result in death from cervical
cancer. But no right-thinking medical professional would ever suggest
doing away with Pap smears. Quite the contrary, they suggest being
tested more often and by labs that can be trusted. False-positive tests
can always be repeated.

Likewise, in AIDS, T cells can be checked to discover where the
person stands on the continuum of normal to suppressed immune system all
the way to severely suppressed immune system. Then, if one wanted
further information, the virus could be cultured.

So false positives do not seem to be a valid argument against doing
widespread voluntary testing. If there are 12,000 persons in the United
States (as is estimated by the CDC) who have AIDS positive antibodies as
a result of blood transfusions, shouldn't we accelerate testing
until we find most of those 12,000 people? Even if it meant testing 1
or 2 million blood recipients, it would seem worthwhile. In California,
the Irwin Memorial Blood Bank reported that at one point prior to the
antibody-screening test, one out of every 100 units of blood was
infected with the AIDS virus. We should identify the 12,000 persons who
are now AIDS-antibody positive from blood transfusions. We prefer to
call these people AIDS carriers, for it is almost impossible for anyone
to test positive for AIDS antibodies (in a confirmatory Western blot
after two positive ELISA tests) without having the virus in the blood to
cause the antibody.

Some of the persons who had blood transfusions have already died
from AIDS. But the remaining persons could be tested at a cost that
would be nominal compared to the expense of having this group of AIDS
carriers spreading the AIDS virus innocently.

The public should insist that enough funds be allocated to
guarantee that private and public AIDS-testing laboratories be brought
up to Minnesota standards so that extensive, voluntary testing can go
forward.

Photo: The AIDS MOBILE got a warm welcome at the Teen Challenge
homes in Harrisburg; Pittsburgh; Rehrersburg, Pennsylvania; and
Wheeling, West Virginia. It was an inspiration to the
counselor-phlebotomists to meet the rehabilitiated drug addicts. To
date, the AIDS MOBILE program has tested 1,056 persons; 28 have been
confirmed AIDS-antibody positive.

Photo: We love our AIDS patients in Indians, and Deborah Taylor is
loving proof. Formerly AIDS coordinator for the Indiana State Board of
Health, she now heads the AIDS MOBILE. Don Radford (left) and Jim
Miller, both AIDS patients and gay, helped her compile ways to stay
healthy longer--with AIDS (see next page).

Photo: This is Belle Glade, Florida, with the highest number of
AIDS patients per capita in the country. Dr. Deanna James (left)
struggles with an overload that will worsen when Dr. Rodney Young soon
returns to his practice in Miami. We ask what churches there are in her
community with the hope that denominations throughout the country might
work with their sister churches in Belle Glade to help educate their
drug addicts. The bottom line: Belle Glade men sell their bodies for
cocaine and bring AIDS to their wives and girl friends, who bear tragic
AIDS babies.

COPYRIGHT 1988 Saturday Evening Post Society
No portion of this article can be reproduced without the express written permission from the copyright holder.